Joan Kuhnly, DNP, APRN, NNP-BC, IBCLC, CNE
“Exploration of Factors Related to the Prevalence of Sustained Breastfeeding in Infants Born Between 35-37 6/7 Weeks Gestation”
Background: The late preterm (35-36 6/7 weeks gestation) and early term (37-37 6/7 weeks gestation) infant exhibits physiologic risk for less than adequate nutritional intake when exclusively breastfeeding. There is little evidence to support the best practice to produce the outcome of sustained breastfeeding in this population.Purpose: The purpose of this pilot, exploratory, correlational study was to determine the prevalence of sustained breastfeeding in late preterm and early term infants at one and two months of age and to identify the factors that were related to sustained breastfeeding.Methods: Subjects were identified through purposive sampling, consented to participate, and completed the Breastfeeding Self-Efficacy Scale. Lactation support, supplemental feeding methods used, hospital course and demographic factors were collected. At one and two months of age, telephone structured interviews determined the current feeding status and assessed post discharge lactation support.Analysis and Results: Descriptive statistical, contingency table methods and bivariate logistic regression analysis was conducted on the sample of 125 mothers. Of those mothers, 82% experienced sustained breastfeeding at 1 month, and 71.2% experiencedsustained breastfeeding at 2 months. A sensitivity analysis was conducted to determine if the noncompleters biased the sample. Significant results still found sustained breastfeeding at 2 months associated with a college complete education (p=0.014), higher Breastfeeding Self-Efficacy scores (p=0.046), and the practice of skin to skin on day 2 or later (p=0.007). High breastfeeding assessment scores on day 1 (Via Christie) were associated with sustained breastfeeding at 2 months (p=0.007) and high day 2 or later breastfeeding assessment scores were associated with sustained breastfeeding at 1 month (p=0.000) and 2 months (p=0.001). Unsustained breastfeeding at 1 and 2 months was associated with the occurrence of supplemental feedings (p=0.001) and pumping at discharge (1 month p=0.002, 2 months p=0.015).
Discussion: Identifying the high sustained breastfeeding rate in this population and the potential factors associated with that outcome, built evidence on what factors should be included in the professional organizations’ clinical practice guidelines and protocols, subsequently tested on larger samples in multicenter studies, and therefore lead to impact clinical practice and national public policy regarding the Family Medical Leave Act.
Key Words: Breastfeeding, late preterm infant, early term infant, lactation support, sustained breastfeeding, supplemental feedings, Breastfeeding Self-Efficacy